Successfully Implementing a High-Sensitivity Troponin Assay with Your Clinical Colleagues

My name's Pete Kavsak. I'm a clinical chemist here at the Juravinski Hospital in Hamilton Health Sciences, in Hamilton, Ontario and I'm also at McMaster University. Cardiac troponin, there's two types of assays. There's a contemporary cardiac troponin assay as well as a high-sensitivity cardiac troponin assay. About four years ago, we had the pleasure to actually transition to a high-sensitivity cardiac troponin assay.

So, our first step, and this is kind of a redundant step, but you should be doing this, just to see whether or not you are currently using your troponin test appropriately. Are you using the right cutoffs for your current contemporary troponin assay? That's important because sometimes what we've seen is that people will make a transition to high-sensitivity assay.

There'll be some disconnect between, you know, perhaps some elevations that they see with the high-sensitivity troponin assay. and not with the contemporary assay. So overall, there's a little bit of clinical disconnect on that using the recommended cutoffs as per the guidelines. That's an important first step. So, step two is to review the evidence of the added benefit of the high-sensitivity troponin assays.

Now in 2018, there's abundant manuscripts evidence to suggest the utility of added benefit and utility of using a high-sensitivity troponin assay as compared to a contemporary assay. So as a laboratory and as an institution that's thinking of adopting a high-sensitivity assay, you better know the reason why you're doing it and what are the added benefits when you go to that switch.

It makes it easier when you actually have the discussions with your clinical colleagues, which is step three. The high-sensitivity troponin assays you've already reviewed, that works really well, you know, the evidence behind it. You want to have that clinical discussion, you want to have a collaboration. It's not the lab initiative, it's the whole hospital's initiative to go to this.

So, you want to make sure you have those early discussions with your key clinical partners. In this case, you want an emergency department physicians, emergency physicians, cardiologists, obviously, critical care physicians, internal medicine physicians but you want to have those meetings early such that you can discuss on the best way to roll out this test. So step four is what laboratories do pretty well, that's verify pre-analytical, post-analytical aspects.

A little slight differences for high sensitivity troponin assays where I would suggest that maybe it's important for laboratorians to consider is the fact is that, you know, you want to do the three RS and the three RS here aren't reading, writing and arithmetic. It's actually do you have the right quality control to measure high sensitivity troponin assay?

Are you using the right sample type? And most importantly, are you using the right lower analytical limit? Those things are all important and if you're not doing that, you're not really taking advantage of the high-sensitivity troponin tests. Step five is to do dissemination of when you're going to go live with this. We were able to transition seamlessly to the high-sensitivity troponin assay and we've never gone back to a contemporary assay.

A key piece of advice to any laboratory that's planning on implementing a high sensitivity cardiac troponin assay is to know that no test is perfect. There are interferences with every test and high sensitivity cardiac troponin assays despite how great they are, they are also subject to some interferences.

So, as a laboratory professional, it's important that you know what those interferences are. But more importantly, it's really vital that you relay that type of information to your clinical colleagues. Some assays are affected by homolysis, some assays are affected biotins, some assays are affected by macro complexes. Again, no assay's immune to having an analytical problem.

Overall, my last four years after transition to high sensitivity cardiac troponin assay has been easy. Laboratory testing is hard. High sensitivity cardiac troponin makes laboratory testing easy. So it's been nothing but a positive experience at least on the laboratory aspect.

On the clinical aspect, I've also heard from my clinical colleagues of the added benefits of using high sensitivity cardiac troponin testing as well. I think high sensitivity cardiac troponin assays are here to stay, I think that they're definitely a benefit for the laboratory, benefit for the clinical community. And when those things both meet, you know it's going to be a benefit for patient care.

So, it's been nothing but a positive experience.